£90,000 cancer drug price attacked

Pharmaceuticals giant Roche has been criticised by the Government's drugs watchdog after refusing to significantly lower the price of a "miracle" breast cancer treatment.

The high price of Kadcyla makes it "impossible" to recommend for widespread use in the health service, the National Institute for Health and Care Excellence (Nice) said.

The drug, also known as trastuzumab emtansine, is used to treat breast cancer patients with HER2-positive breast cancer that has spread to other parts of the body. It is used when the cancer cannot be surgically removed and the patient has stopped responding to initial treatments.

It can offer these women a last hope, extending the lives of patients by around six months.

But final draft guidance from Nice says that the drug, which costs around £90,000 per patient at its full price, is too expensive to recommend for widespread use in the health service.

The NHS financial watchdog has become embroiled in a row with manufacturers of the drug, saying it is "very disappointed that Roche has decided not to offer its new treatment at a price that would enable it to be available for routine use in the NHS".

Roche said that it had offered to cut the price of the drug and will be appealing against Nice's decision.

Nice chief executive Sir Andrew Dillon said: "Although Roche proposed a discount to the full list price of Kadcyla, it made little difference to its value for money, leaving it well above the top of our specially-extended range of cost-effectiveness for cancer drugs.

"We are really disappointed that Roche were not able to demonstrate more flexibility to help us make a positive recommendation. The company is well aware that we could not have recommended Kadcyla at the price it proposed."

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Jen Cozzone, head of health economics and strategic pricing at Roche, told BBC Breakfast: "We're obviously very disappointed by this news. We know that Kadcyla can deliver something unique to patients.

"This is the eighth time in a row they (Nice) have said no to a new medicine that could potentially extend the lives of patients with advanced breast cancer.

"They are the only ones to be doing this. Nice are the first organisation to say no to Kadcyla. Every other organisation in countries very near us in Europe have deemed Kadcyla to be good value for money at very similar prices to what we're talking about here in the UK.

"At this point the risk is the UK becomes an outlier in terms of their access to innovative medicines that we know can make a difference to the lives of patients."

Ms Cozzone said the company would have to offer a 60% discount on Kadcyla to meet Nice's guidelines.

She said: "That really begs the question whether those additional 5.8 months of life, with fewer side-effects, why would they be worth 60% less to women in the United Kingdom than they would be to women in Sweden or Norway?

"At the end of the day, this is much less a question of price than a question of how value for money is defined by Nice, considering how few cancer medicines they've been able to approve in the last 18 months in particular."

Breast cancer patient Hayley Kalinins said Roche needed to bring the cost of the drug down and work with the NHS.

She told BBC Breakfast: "How can they put a price on somebody's life? That's the hardest thing for me to have to say.

"I'm a mum of four children. This is affecting young ladies, it's not affecting older generations.This is a fast-spreading disease. They need to bring this drug to the NHS.

"It's such a small number of ladies with secondary breast cancer.

"This is the miracle drug. This is the wonder drug. We need this."

Dr Jayson Dallas, general manager of Roche Products Limited, said: "Despite Roche offering a significant discount, we are once again disappointed that Nice has not shown any flexibility on access to Kadcyla.

"Refusing patients access to this drug is an incredible injustice and tantamount to turning the clock back in cancer research and development. We plan to appeal this decision."

In a statement, the drug company added: "Under Nice's current process, Kadcyla would need to be discounted by 60% to meet the Nice cost-effectiveness threshold.

"This and other recent rejections (of therapies for advanced breast cancer) highlight that the Nice process is no longer fit for purpose to provide patients access to new cancer medicines."

The drug is available in England through the Cancer Drugs Fund, but doctors must make special requests to access the treatment for their patients and are not able to offer it to them immediately, if at all. Patients in other parts of the UK do not have access to such a scheme.

Breast cancer charities have expressed their disappointment at the news.

Mia Rosenblatt, head of policy and campaigns at Breast Cancer Campaign, said: "We are very disappointed by today's news and know that it is a huge blow for women with HER2-positive advanced breast cancer. It is vital that this is not the end of the line for Kadcyla in respect of Nice approval and we ask Nice and Roche to urgently re-visit their negotiations to find a solution."

Emma Pennery, clinical director at Breast Cancer Care, said: "Kadcyla being rejected from routine NHS access will come as another devastating blow to women with HER2 positive advanced breast cancer, denying them the chance of a longer and much better quality of life."

Breakthrough Breast Cancer's senior policy officer Sally Greenbrook said: "We believe all cancer patients should be able to access the best possible treatment but for this to happen within the confines of the NHS budget, prices set by the pharmaceutical industry for impressive, life-extending drugs such as Kadcyla must come down.

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"It's impossible to put a price on life's precious moments. But it's not impossible to put a fair price on drugs.

"We want to see the Department of Health and the pharmaceutical industry working together to find a long-term solution to this ongoing problem and a sustainable system put in place by which new treatments can be made available to those that need them."

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